Prolapsed Intervertebral Disc

Understanding the back

The spine is made up of many bones called vertebrae. These are roughly circular and between each vertebra is a disc. The discs are made of strong rubber-like tissue which allows the spine to be fairly flexible. A disc has a stronger fibrous outer part called annulus fibrosis and a softer jelly-like middle part called the nucleus pulposus.

The spinal cord, which contains the nerves that come from the brain, is protected by the spine/vertebral column. Nerves from the spinal cord come out from between the vertebrae to relay messages to and from various parts of the body.

Strong ligaments attach to the vertebrae. These give extra support and strength to the spine. Various muscles also surround, and are attached to, various parts of the spine.

What is a prolapsed disc?

                        

              When you have a 'slipped' (prolapsed) disc, a disc does not actually slip. What happens is that part of the inner softer part of the disc (the nucleus pulposus) bulges out (herniates) through a weakness in the outer part ( annulus fibrosis )of the disc. A prolapsed disc is sometimes called a herniated disc. The bulging disc may press on nearby structures such as a nerve coming from the spinal cord. Some inflammation also develops around the prolapsed part of the disc.

Any disc in the spine can prolapse. However, most prolapsed discs occur in the lower back (the lumbar spine). The size of the prolapse can vary. As a rule, the larger the prolapse, the more severe the symptoms are likely to be.

Stages of Disc herniation

Causes for slip disc

1)     Heavy weight lift

2)     Sudden bending downwards

3)     Any jerk to back or fall

4)     A job involving lots of lifting.

5)     A job involving lots of sitting (especially driving).

6)     Weight-bearing sports (weightlifting, etc).

7)     Smoking.

8)     Being overweight (obesity).

9)     Increasing age (a disc is more likely to develop a weakness with increasing age)

What are the symptoms of a prolapsed disc?

Back pain

The pain is often severe and usually comes on suddenly. The pain is usually eased by lying down flat and is often made worse if you move your back, cough or sneeze.

Nerve root pain (usually sciatica)

                         

Nerve root pain is pain that occurs because a nerve coming from the spinal cord is pressed on (trapped) by a 'slipped' (prolapsed) disc, or is irritated by the inflammation caused by the prolapsed disc. Although the problem is in the back, you feel pain along the course of the nerve in addition to back pain. Therefore, you may feel pain down a leg to the calf or foot. Nerve root pain can range from mild to severe but it is often worse than the back pain. With a prolapsed disc, the sciatic nerve is the most commonly affected nerve. (The term sciatica means nerve root pain of the sciatic nerve.) The sciatic nerve is a large nerve that is made up from several smaller nerves that come out from the spinal cord in the lower back. It travels deep inside the buttock and down the back of the leg. There is a sciatic nerve for each leg.

Other nerve root symptoms

The irritation or pressure on the nerve next to the spine may also cause pins and needles, numbness or weakness in part of a buttock, leg or foot. The exact site and type of symptoms depend on which nerve is affected.

Cauda equina syndrome - rare, but an emergency

Cauda equina syndrome is a particularly serious type of nerve root problem that can be caused by a prolapsed disc. Commonly caused due to disc prolapse at the last segment of lumbar spine L5-S1. There is central disc protrusion with large base and compressing on cord and nerve roots ( Cauda equine ) .This is a rare disorder where the nerves at the very bottom of the spinal cord are pressed on. This syndrome can cause low back pain plus:

·       Problems with bowel and bladder function (usually inability to pass urine and motion ).

·       Numbness in the saddle area ( Private parts )  around the back passage (anus).

·       Weakness in one or both legs.

                                                           

This syndrome needs urgent treatment to preserve the nerves to the bladder and bowel from becoming permanently damaged. See a doctor immediately if you develop these symptoms.

Treatment

Medications in the form of painkillers and muscle relaxants

Should be used on short term basis , should not be the definitive management.

Physiotherapy in the form of modalities and exercises ….

IFT

TENS

Hot packs

Pain Block

Surgery in the form of Microscopic Discectomy ….

Indications for surgery ….

1)     Failed conservative management

2)     Severity of symptoms

3)     Weakness in lower limbs

4)     Numbness in private parts

5)     Difficulty in standing and walking

6)     Difficulty in urine and motion